Picky Eating Disorder: How to Help Your Picky Eater

It may seem that most children are picky eaters.  In fact it sometimes seems like a child that isn’t considered a “picky eater” by his parents is the exception, rather than the norm. However, not everyone is going to actually have picky eating disorder.

If you’re concerned about your child being a picky eater, it’s important to consider a few different strategies for resolving it.

Firstly, is your child simply ‘choosy’ or indeed a ‘problematic’ eater with a picky eating disorder? How can you tell the difference?

Secondly, if your child is simply choosy, what are some proven techniques for you to encourage healthy meals for picky eaters?

Furthermore, how do you know when professional intervention is necessary to ensure your child is growing in a healthy way?

Choosiness or a Picky Eating Disorder? How Can You Tell?

The reality is that the majority of children really are considered ‘picky eaters’ by their parents. One study reported 56% of children at 15 months old were considered choosy about their meals! Picky eaters are found at all ages for both sexes, all ethnicities, and all ranges of household incomes. (2)

When I am working with a family concerned about a child being an extremely picky eater, I most often refer to a program called SOS.

The Sequential-Oral-Sensory feeding program guides caregivers and paediatric specialists. It guides them in a systematic, scientifically-supported approach to determine how problematic their pickiness is in their overall health.

In order to make a formal assessment of your child’s eating habits, a trans-disciplinary team consisting of a paediatrician, psychologist, occupational therapist, speech pathologist and dietitian observe the child eating with his or her primary care givers in a clinic setting.

If you’re concerned about whether or not to ask your paediatrician for a formal assessment, here are a few guidelines to consider:

Children are considered ‘choosy’ eaters when they:

• Will eat around 30 different food varieties.
• Will resume eating a previously-unwanted food after a 2 week break.
• Are able to tolerate touching and tasting a new food, even if reluctant to do so.
• Will eat at least one food from various texture categories.
• Will usually eat with the family, even if they have a different meal than everyone else.
• Can learn to tolerate new foods by following the first 15-25 steps of the SOS Steps to Eating Hierarchy

Children are considered to have a problematic, picky eating disorder when they:

• Will eat less than 20 different foods.
• Will not resume eating a previously unliked food, even after 2 weeks.
• Have a meltdown when encouraged to try a new food or an unliked food.
• Will not tolerate any food from certain texture categories.
• Almost always eats different foods than the family.
• Require more than 25 steps on the SOS Steps to Eating Hierarchy in order to tolerate a new food.

Tips for Encouraging Healthy Eating in Picky Eaters

If you’re dealing with a choosy or picky eater (as opposed to a child with a problematic picky eating disorder) here are some strategies. These are strategies to help you on your quest to develop a well-rounded, healthy eater. They are taken directly from scientific research studies, paediatricians, and occupational therapists like myself.

1. Try not to fuss and worry too much.

What’s really interesting about the study I referenced earlier was that of those picky eaters, 83% went on to become normal, well-rounded eaters. What was the biggest overall factor determined as the difference from those that didn’t? Mothers who were overly-concerned.

The overall message from this study is an interesting one. Could it be that mothers who are overly-concerned about their child’s eating habits are influencing their child’s pickiness even more?

As frustrating as it may be, try to relax yourself around mealtimes.

2. Set some mealtime rules that include required bites and tastes.

Provide 3-4 options on the plate. Provide one of each of:

• a food that you know your child loves,
• one that your child doesn’t really care for but has to eat three bites of, and
• one that your child has never had and must taste one bite.

Portion the food that your child loves in two parts.  Put one half on their plate and half on your own plate. This way, he/she earns the other half of the yummy portion! 

When he/she has finished the required bites and tastes of the others, they earn the rest. For example, give one dinner roll, broccoli, and chicken on your child’s plate. If he eats three bites of chicken and one taste of broccoli, he can earn a second dinner roll from you.

3. Eat together.

Children that eat alongside their family tend to eat better in general. (2)

4. Offer fresh fruit at every meal.

Fruit comes in a variety of textures, colours, and tastes.  However, it is generally sweet and enjoyable to most children. (2)

5. Even if your child routinely turns down a certain food, try, try again.

Children who were offered a food 8-15 times were more likely to accept it. However, most parents give up after 3-5 refusals. (2)

Picky Eating Disorders: When Picky Eating is Problematic

Some children do have genuine issues. They can have genuine medical, emotional, neurological or developmental challenges. These challenges make it impossible for them to adapt to eating a wide variety of foods.

Some examples include:

• Posture, core muscle weakness
• Motor skills & coordination challenges
• Behavioral/learning disabilities
• Medical and nutritional factors
• Sensory processing disorder

Sensory Processing Disorder (SPD)

Some children obsess over certain food textures or temperatures and can’t get through a meal without help. Children like these who are sensitive to elements in their environment are said to have sensory issues. Some have a condition called Sensory Processing Disorder.

(Read more about how Sensory Processing Disorder affects children differently here Types of Sensory Processing Disorders). SPD is my particular area of expertise. So, if you believe your child has issues with eating due to SPD, feel free to contact me. 

We can set up a free, 15-minute consultation with myself or one of our qualified paediatric occupational therapists at CoordiKids.  We can show you how to create a strategy for helping your child with in-home therapeutic exercises.

Intervention for Problematic Picky Eating Disorders Using the SOS Method

For children facing these challenges, the SOS feeding method was developed.

This SOS Method was developed to integrate:

• posture,
• sensory,
• motor,
• behavioral/learning,
• medical and
• nutritional factors

to comprehensively evaluate and manage children with eating/growing disorders.

The four basic tenets of the SOS approach are:

1 = Myths About Eating interfere with understanding and treating feeding problems.

2 = Systematic Desensitization is the best first approach to feeding treatment.

3 = “Normal Development” of feeding gives us the best blueprint for creating a feeding treatment plan.

4 = Food Hierarchies/Choices play an important role in feeding treatment.

Some of the techniques utilized by professionals in the SOS Feeding Approach:

• For children between 18 months and 7 years of age, eating in a group of similarly-challenged children significantly increases their ability to develop better eating habit. (approximately 25% more rapid progress than in individual therapy).
• Each feeding session begins with a set routine.  The routine includes actions such as breathing and oral motor skills exercises, hand washing.  Also, it includes a lesson about the food.
• Some children require sitting stability exercises and hand-eye coordination exercises through occupational therapy.
• Therapists work on oral-motor and perceptual deficits through the choices of the foods made.  And also the way in which they are presented (tastes, sizes, textures, shapes, colours, consistency, temperature).
• Children are advanced up a detailed hierarchy of 32 steps to eating with each new food presented. Therapists interact with the food and children in a way to help the children achieve each of the 32 steps from a skill standpoint.
• Children are encouraged, through positive social reinforcement, each step on the 32 steps to eating hierarchy.

At-home Strategies for Parents

If your child suffers from a sensory processing disorder that affects his/her ability to eat properly, I encourage you to seek professional intervention. Occupational therapists and speech therapists both offer therapeutic exercises. 

These are exercises that you can work on at home. They serve to help your child close the gaps in development that cause oral sensory or coordination problems. Here are a few of the techniques we use.

For example:

Oral Motor Development Exercises

1. Opening and closing the mouth
2. Puckering the lips as if to give a kiss
3. Big smiles
4. Opening the mouth and trying to pucker with mouth open
5. Pressing lips together
6. Tongue mobility – sticking out the tongue, moving it side to side
7. Open the jaw and move it side to side
8. Throat muscle contractions
9. Blowing bubbles
10. Sucking through a straw

In addition to physical strengthening and coordination, follow the same suggestions for picky eaters:

• keep mealtimes fun;
• don’t exert pressure or force to eat;
• explore touch,
• smell and light taste before trying to chew and eat.

Consider CoordiKids For In-Home Therapy Exercises

If you’re unsure where to start with evaluating your child’s picky eating habits, we can help.  Start with a 1 hour consult phone call to us at CoordiKids on our CoordiConsult service.

We are a team of paediatric occupational therapists that help children facing sensory motor, fine and gross motor skill challenges.  We help them access world class, fun and affordable occupational therapy exercises and activities – from anywhere! With online access.

A one-hour phone, Skype (or similar service) consultation offers a confidential meeting online at a time that suits you.  It can be in the comfort of your own home, office, classroom, or anywhere!

Discuss your concerns, tell us about your child’s habits. And one of our professionally trained paediatric therapists can help you design a plan to help your family. Our programs, like CoordiKids Home course, include oral motor skills for children with oral sensory challenges.

Mealtime shouldn’t be stressful or traumatic! Let’s work together to help your family enjoy mealtime again!

(1) https://www.sciencedirect.com/science/article/pii/S019566631830446X

(2) https://www.sciencedirect.com/science/article/pii/S0002822303014925

(3) SOS Feeding Approach techniques Copyright 1998/2010 Kay A. Toomey, Ph.D